Chapter 6

Crisis, Trauma and Fostering Resiliency and Recovery

1. Purpose. Crisis and trauma within the Navy Expeditionary Force can happen at any time - in theater, during training, or at home. Crisis comes in many forms and every situation is unique—a new set of orders that requires a change in geographic station may be “business as usual” to an experienced spouse, but to a newlywed or dependent children the orders may induce panic. The nature of the missions undertaken by NECC forces requires commands to prepare Sailors and families for the most challenging crises imaginable—natural disasters, injuries involving Sailors and/or family members or possibly death. Planning and preparation for these ‘worst-case scenarios’ will enable individuals to deal with the smaller crises that populate every day. It is important to understand and remember three groups may be impacted by crisis/trauma. The impacted sailor and family, The Command and families (friends, team mates) and the CFRT members (to include Chaplain, CACO, Leadership and volunteers) In order to prepare, it is important to have a basic understanding of how individuals respond, what are the stressors of the event, individuals’ needs, and what resources are (or will be) available to support the CFRT, Sailors and their families. The intent is to minimize the impact of events that can be traumatizing for the command, Sailors, and families and to foster resilience, recovery and personal growth following a trauma. This chapter discusses the responsibilities of the CFRT for planning, preparation and confronting a crisis. It introduces the concept of a Casualty Response Team (CARE Team) built around certain CFRT billets. It also highlights the roles of some key positions outside of the CFRT that may be involved in crisis response and the aftermath. Finally the chapter provides basic information on trauma and practical approaches to responding to it. 2. CFRT Responsibilities in Crisis. The roles and responsibilities specified in Chapters 2 and 3 are applicable in a crisis situation. This listing identifies duties and tasks which may not ordinarily be carried out, but are necessary to maintain overall readiness and address the needs of the command when confronting a crisis. a. Commanding Officer – Leader of the command. The CO must balance the needs of the Sailors and families directly impacted by an event with the charge to maintain operational readiness of the command. b. Command Master Chief – Oversees communication concerning an event within the command and externally through the FRO to command families. c. Leadership Spouses: Can be a member of the CARE Team

d. Family Readiness Officer (FRO). During CACO or other emergent response operations the FRO will be the understood “team leader”, coordinating response support with the Ombudsman (OMB) and Family Readiness Group Leader (FRGL) in support of the impacted family and command families. The FRO will collaborate with the Ombudsman and FRGL to conduct relief efforts and offers of support (donations, visiting, updates, meal teams) allowing command leadership to continue operating in their critical mission role. e. Ombudsman (OMB) facilitates communications between the command and command families. A member of the command care team (COMNECC trained). f. Family Readiness Group Leader (FRGL) coordinate FRG volunteer team response. A member of the command care team (COMNECC trained). g. CAsualty REsponse (CARE) Team. A group of 3-4 volunteers who are trained to support the family of a deceased/wounded Sailor immediately after a notification of a death or serious injury. These volunteers also provide coordinated support for command families. CARE Teams revolve around OMB and FRGL, but exist to alleviate the full "burden" of care for an impacted family from the OMB/FRGL so that they may also focus on the larger issues of readiness during crisis (secondarily, the possibility of multiple casualties necessitates the CARE Team having individuals other than OMB and FRGL). Other members are appointed by the CO and can include leadership spouses, past experienced ombudsman and FRGL’s. CFRT’s can also utilize command approved volunteers from other units. All must be NECC CARE Team trained.

(1) What a command CARE team can do to support the impacted family and command families:

• Communication support • Home care assistance • Childcare support • Meal support • Transportation • Assistance to visiting family • Other family support

Policy and regulations may preclude certain members within the Command CARE Team from performing specific missions (e.g. Ombudsmen cannot physically provide childcare support.) Commands should be aware of these restrictions. Note:    CARE Team support will only be utilized at the request of the impacted family. The CARE Team volunteers will provide meaningful and practical assistance that complements the assistance provided by the CACO, Chaplain and TRIAD so that the family can continue to function while dealing with a traumatic event. The actual support

provided depends on family needs and command guidance. It is important to stay within the guidelines provided Navy and COMNECC instructions. More information about the functions and practical actions of a CARE team is provided later in this chapter. The information will also be helpful for CFRT members.

 

3. How Should A Command Respond To A Traumatic Event? How a command responds to a traumatic event will have direct impact upon how Sailors and families perceive the command and its leadership. It is vital to establish proactive plans that address preparedness, response and recovery phases. a. Preparation Phase: Due to the various mission types of NECC commands it is important to understand that preparedness is not limited to a scheduled deployment. (1) Ensure Care plans and CPFRP forms “Contact sheets” are current and the location, usage and access of the forms are known and understood to the CFRT. (2) Ensure NFAAS, page 2’s etc. are current. (3) Review pertinent Navy and local SOP’s on Disaster preparedness and response plans. To include; “Operation Prepare” http://www.cnic.navy.mil/CNIC_HQ_Site/WhatWeDo/FleetandFamilyReadiness/FamilyReadiness/FleetAndFamilySupportProgram/DIsasterPreparedness/index.htm (4) Ensure all CFRT members have a clear understanding and are included in the planning of the Disaster Preparedness and response plans. It’s important that CFRT members proactively communicate with the families of known impending natural disasters, events (etc) with plans and resources available. If the command is deployed communicate to both the Sailors and Families. (5) FRO’s and Ombudsman will be included in Command Disaster Preparedness Exercises and understand their role in disaster preparedness and response.

(6) Review pertinent Navy policies on Casualty procedures including; notification procedures, mass casualty response, and policy variations if incident occurs in battle space of another service branch (Geographic Combat Commander Rules) (7) Ensure all CFRT members are included in the planning and have a clear understanding of casualty procedures, an understanding of the services a CACO provides assistance and the command response plan. To include care for the impacted, care for the command and families and care for the CFRT members.

(8) Have key points of contact (e.g. CACO, Chaplain, Installation CACO, Casualty Assistance Center, Safe Harbor, Memorial Affairs Operations Center, and Medical Treatment Facilities, Tragedy Assistance Program for Survivors, and other resources that may be available to specific communities within NECC.

(9) Ensure the volunteers have a clear understanding of proper communication methods to include what information to share and what information should not

(10) Ensure Volunteers understand the utilization of Chain of command.

(11) Ensure that the role of the FRO’s, Ombudsman and FRGLs is not to participate in notification process or to interfere in the CACO’s administration of their duties. (12)If a Regional CACO is utilized the Commanding Officer is highly encouraged to send a uniformed Command Representative to further support and connect with the family, similar in spirit to the “Special Escort”. The use of a command representative has great benefits to a family who has just suffered a loss. The ability to talk to a friend of the deceased, attend the funeral, assists the family in their grieving process.   (13) Establish a strategic communication plan that allows information from command (including deployed commander) to be quickly and accurately disseminated to families. Meet with CFRT members and leadership to develop a communication strategy amongst the CFRT members and also to the command Sailors and families.   b. Response phase

(1) Provide a prompt response. Talk plainly and honestly to families.

(2) Meet basic needs. (3) Focus intervention on decreasing risk factors and

strengthening protective factors. Do not assume individuals’ reactions are signs of mental health problems/disorders, especially in early phase.

(4) Include families in the healing process. Conduct memorial services that provide opportunity for tributes and shared mourning. Involve employers and schools in community memorials. (5) Provide information to help individuals understand normal reactions and recovery process. This is helpful in normalizing the experience for individuals and helping individuals to have realistic

expectations for recovery. Keep in mind that most people will not need counseling, but they will need education and resources. Provide psychological first aid for acutely distressed individuals through referrals and resources available.

(6)The emotional response will be broad and many will feel the “realness” of the situation; sometimes great grief comes from those who are the least expected. Listen to the Sailors and families and respond accordingly. Observe pattern changes, risky behaviors, anxiety, outbursts, and anger. It is important for CFRT to discuss command climate, situations of concern.

(7)Realize that discomfort and awkwardness occur for everyone involved in the situation. People who want to help may feel guilty because they have not suffered their particular tragedy or they simply may not know what to do or say.

(8)Conduct crisis communications to control rumors, calm people and reduce people’s sense of risk. Be honest in communications. By providing open, clear and honest communications in times of heightened anxiety will help mitigate rumors, misinformation and negative perceptions.

(9) Conduct Informational and family resiliency briefing for command and families within a few days’ hours of casualty or disaster (etc)

(10)Ensure CFRT members and Care team members are aware of resources and methods avoid burnout or compassion fatigue.

(11) Tailor support or intervention efforts to particular groups. Pay special attention to sailors or families close to the impacted sailor/family. Such as detachment/company member, department co-worker, or close friend. In addition to the grief for the loss, families may have added concern for their Sailor especially if they are deployed. Sailors if deployed may have concern for their families. Be aware of the impact of survivor’s guilt on both the service member and spouse.

c. Recovery phase (1) Facilitate community healing. Consider opportunities for families to connect and lean on each other and even laugh. Doing so will help reduce stress and remind families they are not alone. (2) Continue to monitor needs, mental health issues and functioning. Get individuals with psychiatric diagnosis into treatment rapidly.

(3) Continue to conduct outreach to connect and provide information to build people’s resilience and coping skills.

(4) If an incident occurred while on deployment; upon the expected return of the remaining Sailors, discuss with the CFRT separate post-crisis reintegration brief with the spouses. Consider having a counselor, Chaplain facilitating an opportunity for families to discuss concerns and understand what to possibly expect of their returning sailor, their own emotions, and any other topics that arise.

(5)after assisting the family, an After Action Review (AAR) may be scheduled. This review provides a process for CFRT members and

Care Team members to discuss the sailor and family readiness support and make notes on what went well, what could’ve been changed, etc. No response program runs smoothly or without incident. The AAR serves as

a tool filled with best practices and lessons learned to change current response methods and for future command CFRT’s. The input is

very valuable.

4. A general understanding of Sailors and Families Emotions and Reactions:

a. Having an understanding of how and why Sailors and families react the way they do to traumatic events can be helpful to dealing with family’s emotions. Specific guidance on dealing with grief and trauma reactions is also provided in their section and at the beginning of their chapter.

b. Understanding Reactions to Trauma Events. Individuals’

reactions to traumatic events vary so it cannot be assumed how a sailor and family will react. Reactions tend to be multi-faceted, meaning there are physical, emotional, cognitive, and behavioral reactions. Many factors can influence how any given individual reacts so it is not possible to predict how a Sailor or family will react to a traumatic event. The reactions a Sailor and family exhibits are a response to the stress, fear, vulnerability and loss the sailor and family has experienced or is feeling.

c. When a traumatic event occurs, a family experiences:

(1) An unexpected event (2) Injury or death of a loved one (3) Loss (a) Personal loss such as loss of husband/parent (b) Symbolic loss such as loss of sense of security and loss of identity

(c) Ambiguous loss (i.e., the uncertainty of family unit and relationships as in case of seriously wounded, POW and MIA) (4) A prolonged sense of crisis or lack of control feeling (a feeling that can arise from the sense “their whole world has just turned upside down” and the life change that has just occurred) (5) Additional stressors (family now faces decisions and matters that have to be addressed, etc.).

Note: It is common for a sailor and family to struggle to find meaning in the event (i.e., “why did their happen?”). Thus, reactions initially following the trauma event may be intense, but not always. Reactions do tend to change over time as the Sailor and family moves through the recovery process and transitions to the new situation. During the recovery process, there will be good days and bad days for a sailor and family until they are able to thrive. Keep in mind that it will take time for a Sailor and family to recover. The length of time to recover will vary across families and across individual family members. 5. CFRT in Crisis Response mode: As mentioned above there are three groups impacted by crisis and trauma, below provides some baseline insight. The information is centered on the worst case scenario. As the CFRT develops an understanding of roles and exercises its ability to communicate and collaborate so that each member is ready in the event a Sailor is killed or wounded. A CFRT which is prepared to address a traumatic situation is an asset that enables the command to continue with the mission It is important to keep in mind that there are three groups impacted when a traumatic event occurs: (1) Sailors and Families directly affected. (2) Families (i.e. remaining Sailors and Families in the command, including those temporarily assigned to the command). (3) Family Readiness Command Team and support staff. This can include leadership, FRO, CACO, Chaplain and Volunteers etc. Each trauma event and family (both their reactions and needs) is different so CFRT members and Care Team members need to view each situation as unique. This means that CFRT will need to think on their feet and adjust to the situation. The key to providing valuable support is to take cues from the family; to be flexible and adaptable as the situation changes, and to never lose sight of the fact that the family is the primary focus. The family is going to have good days and bad days. So please remember not to take things personally, and encourage others also to be tolerant and kind. The family is going through a difficult situation, and the CFRT role is to help make it a little easier, not add to it in any way.

a. Understanding the Notification Process. Having a general understanding of the Casualty notification process and casualty assistance program is helpful in seeing how individual members fit into the overall efforts to support families of casualties. With their knowledge, the CFRT can support the command, Sailors and families more effectively. b. How are families notified of a casualty? The casualty notification process varies depending upon the type of casualty. If a sailor is deceased (i.e. Death, Whereabouts Unknown or Missing in Action) the family will be notified in person. In the case of an injured Sailor, notification depends upon the nature of the Sailors injury. Generally for very seriously injured (VSI), or seriously injured (SI), the Command or CACO will notify the next of kin in person or by telephone. When the sailor is not seriously injured (NSI), the PNOK is notified by telephone if the illness or injury is a result of hostile action. In these cases, the Sailor generally notifies their family. 6. Who else assists the family? There are several individuals and agencies designated by the Navy to respond when a Sailor injury or death occurs. It is important to understand the role and responsibilities of these individuals and not conduct tasks performed by these individuals. The best response and support provided to a family is a coordinated effort and team approach. (1) Casualty Assistance Calls Officer (CACO) The CACO is responsible for notifying the Primary Next of kin (PNOK) and Secondary Next of kin (SNOK) and any other person listed on the Sailors page 2. The CACO provides support to the family and aids with personnel related matters such as provide survivor benefit information and assist with funeral arrangements. (2) Chaplain: The role of the chaplain is to accompany the CACO when notification is made in person. The Chaplain offers pastoral counseling, comfort and solace to families. The Chaplain is also a source of information about religious observances and funeral services. (3) Public Affairs Officer (PAO) A Public Affairs Officer may contact the family to offer information and guidance on dealing with the media. (4) Personal affects: A member of the command is appointed to collect, inventory, safeguard, and send the effects of the deceased Sailor to the place requested by the NOK.

Take into consideration the type of incident when providing support:

Wounding: When illness or injury strikes, the impact can be almost as devastating as a loss. Because of the varying degrees and seriousness of illnesses and injuries, those in support roles (including the family) may be confused about, or have questions concerning, the best way to give support and what’s resources and programs are available.

Suicide: For surviving family members dealing with the aftermath of a suicide, the grieving process can be compounded by feelings of failure, shame and guilt. Being sensitive to the unique nature of their loss will better enable you to provide comfort and support.

MIA/POW: Families of MIAs and POWs are forced to deal with the “not knowing.” This highly emotional and painful ordeal is exacerbated by the fact that the suffering might have to be endured for an indefinite period of time. Mass Casualty: Multiple injuries and/or deaths are certainly one of the most difficult situations a military command might face. Discussing the potential of this scenario with the CFRT prior to this occurring is paramount to handling this tragedy in a way that honors each Sailor and his/ her family

d. Caring for “Others” Sailors and families in times of CACO or crisis response.

e. f. How the “Trauma” is handled by the Command Triad, CACO,

Ombudsman, FRG, FRO and Chaplain has long term affects on the grieving command families. The ‘Command Family’ may grow and strengthen as members see how we care for each other and respond to these situations. This can be an emotional time for the families of your Command, as it can highlight the harsh realities of the community in which the Sailor works. Follow the Command Crisis Response plan and follow up on any changes or new instructions regarding the specific incident. CFRT teamwork is essential.

(1) Coordinate and schedule informational and Resilience

briefing: Determine the agenda. Families typically want to know the basics of what happened, who was involved, how the impacted family is handling the situation, how is the impacted sailor and/or family is being cared for and how can they provide support. During their meeting, families want to understand how to support their Sailor, their emotions and the Command, and what to expect in the

near future. Its important center the meeting and speakers around the type of crisis/trauma event that occurred. Such as, if a families Sailor is still deployed anxiety will be heightened. If a suicide occurred the command and families may feel as sense of failure, shame and guilt.

2) Provide resources and options; A Chaplain, FFSC counselor, Mental health support failure with the nature and mission of the command and who can discuss and remind families to care for themselves and seek help if needed. Additionally, the emotions of the family can impact a child. The attendance of a counselor can pinpoint how children are affected by loss and grief.

(2) It is necessary to have childcare available to families

during a crisis briefing.

(5) Provide comfort food and enlist support from other Commands to assist with or standby to assist with crisis response. (6) Have sign-up sheets available for spouses/family members to volunteer services for the grieving family, such as making meals, doing yard work, and helping with childcare. Provide to the impacted family a specific list of what services are willing to be provided and by whom. (7) Remember that there are former CFRT members across the NECC force that has firsthand experience in crisis response. They are a critical asset for guidance in these situations. Note: Over the following weeks maintain open communication with your Command families regarding memorials, homecomings of wounded warriors, locations to send flowers/cards, and support services available to them. h. Taking Care of Self. To support families effectively, it will be important for CFRT to take care of them when assisting a sailor or family. This involves taking steps to deal with own reactions, handle stress, and avoid compassion fatigue. (1) Dealing With Own Reactions. Keep in mind that you may be grieving and/or dealing with your personal reactions to the trauma event. This is especially true if the Soldier was a friend. Allow yourself to grieve. Helping a family can be rewarding and meaningful. However, it is important to be mindful of your reasons for assisting the family. Have realistic expectations of how you can assist the family. This is vital to being able to maintain the empathy and

Physical Symptoms

• Chest pain

• Pounding heart

• Dryness of mouth and

throat

• Shortness of breath

• Muscle aches (e.g., pain

in neck or lower back)

• Trembling, nervous tics,

easily startled

• Stuttering, other speech

difficulties

• High-pitched nervous

laughter

• Grinding teeth; clenched

jaw

• Fatigue

Frequent need to urinate

• Excessive sweating

• Stomach problems (e.g.,

diarrhea, indigestion,

queasiness, vomiting)

• Headache

• Muscle tension • High blood pressure

provide the support needed by the family. Additional guidance is provided in the subsection entitled avoiding compassion fatigue. (2) Handling Stress. Helping a sailor and/or family in distress can take an emotional toll and be stressful. Emotional reactions can be compounded by the leadership positions held. Be aware of the symptoms and signs of stress so that you can take action when you feel stressed. Because individuals display stress in different ways, you may not show your stress in the same way as another CFRT members. Care Team volunteer. Be attentive to what you are personally experiencing.  

It is important to deal with stress right away and in effective ways.  I. TIPS FOR MANAGING STRESS. These tips are designed to increase your ability to cope with the situation and reduce your level of stress.

(1) Maintain health and well-being (a) Take good care of yourself. It is very important to exercise, eat properly, and get enough sleep. Maintaining your health is very important, especially in highly stressful situations.

Emotional Symptoms

• Difficulty sleeping

• Nightmares

• Feeling powerless,

helpless or insecure

• Fear

• Anxiety

• Sadness

• Depression

• Restlessness

• Worrying

• Anger

• Mood swings

• Confusion • Forgetfulness

 

Behavioral Symptoms

• Loss of appetite or

excessive appetite

• Inability to concentrate

• Impulsive behavior

• Irritability; decreased

anger control

• Increased alcohol,

tobacco or drug use

• Apathy; inactivity

• Withdrawal or isolation • Crying spells; crying for no reason; overpowering urge to cry or run

(b) Avoid using alcohol and drugs.

(2) Manage how you approach the situation and your time (a) Take one thing at a time. Determine priorities and pace yourself accordingly. (B) be realistic about what you and can’t do. Ask for help when you need it. (c) Know your limits. Say “no” when you need to do so. (d) Maintain a balance between assisting the family and own personal/family obligations. Maintain contact and spend time with your family (e) Be flexible. Accept that you don’t have control over some situations. j. Take action when “stressed out” (1) Do activities that help you relax? Exercise, meditate, listen to music, or whatever works for you to relax. (2) Do something fun and enjoyable. (3) Take a break. Taking a five minute break or brief walk can be helpful to reenergize. Do not assist a family round the clock, work in shifts.

Sources: National Mental Health Association; Mayo Clinic; AE PAM 600-8-109-1, Family-Focused Deployment Guide; Family Readiness Guide: A Deployment Guide for 3rd COSCOM Soldiers, Civilians and Families Avoiding burn out and compassion Fatigue Note: CFRT/Care team members and other responders are at risk of developing burnout and compassion fatigue. Compassion fatigue (or vicarious dramatization) is when CFRT members/Care team members show signs of posttraumatic stress. It occurs as a result of ongoing exposure to witnessing a Sailors or family’s suffering and hearing about their experiences. Exhibiting some stress symptoms is normal. However, when the level of stress does not diminish, especially after CFRT has ended its assistance, or normal functioning becomes impaired, then it is important to seek professional help. A constellation of symptoms listed in the table below may indicate a need for professional help.

SIGNS OF COMPASSION FATIGUE Physical Symptoms

Cognitive Symptoms

Emotional Symptoms Behavioral Symptoms

• Headaches • Upset stomach (stomach aches, nausea, diarrhea)

• Dizziness • Heart pounding • Flu or cold-like symptoms • Tremors • Sweating • Soreness in muscles, lower back pain

• Exaggerated startle reaction; jumpiness

• Fatigue

• Difficulty concentrating

• Forgetful • Slowness of thinking and comprehension

• Inability to make decisions • Limited attention span

• Loss of objectivity

• Nervous • Anxiety • Fear • Worry • Anger • Mood swings • Flashbacks, nightmares, distressing dreams

• Low self-esteem • Feeling less trusting (cynical and jaded)

• Sadness • Depression • Grief • Feeling overwhelmed, hopeless

• Feeling heroic, invulnerable, euphoric

• Guilt or survivor guilt

• Identification with family/survivor

• Crying episodes • Irritability • Arguing • Aggression • Blaming or criticizing others

• Restlessness • Hyper vigilant about safety

• Social withdrawal, isolation

• Change in appetite

• Change in sleep habits

• Loss of energy • Increased use of alcohol, tobacco or drugs

• Accident prone • Inability to do job

CAsualty REsponse (CARE) Team. As touched on at the beginning of this chapter a CARE Team is group of 3-4 volunteers who are trained to support the family of a deceased/wounded Sailor immediately after a notification of a death or serious injury. These volunteers also provide coordinated support for command families. All CARE team members must attend NECC CARE Team Training.

  (4) When Does A “Care Team”, The OMB and FRG Assist A Family? A Care Team (OMB/FRGL) is sent after the family is notified and ONLY if the family requests their assistance. In the case of fallen Sailors, the Care

Team will be sent immediately following notification. In the case of wounded Sailors, the Care Team may be sent immediately following notification and prior to the family leaving to join the wounded Sailor in the hospital/medical treatment facility or may be sent immediately following family’s return. At the time the family returns, the wounded Sailor may or may not have been transferred to a hospital or veteran’s rehabilitation program in the family’s geographical area.

During CACO notification the Commanding Officer/CMC will ask if the FRO or Ombudsman may contact the family directly:

(a) If the family says yes, the CACO will assess possible family needs before the Ombudsman and FRO contacts the family. The FRO will also offer the type of support the Care team can coordinate for the family. (b) If the family says no, the CO will follow up with the CACO in 48 hours with the same question. It is normal within the first few hours or days for the impacted family to be overwhelmed and thus unsure of what type of support they may want or need. It’s important to communicate what types of support can be provided. It is very important to be ready but wait. (c) The CO will provide guidance to the CARE Team representatives (Ordinarily the OMB and FRGL) prior to the visit to the family. While on site, the CARE representatives may determine, based on family’s requests and perceived needs, that additional support is needed. However, additional suppor requested should be discussed with the command. Note: All members of the CFRT and support organizations should seek clarification before providing any support not specifically cited or prohibited in this manual. Note: Other unit trauma situations in which a CARE Team may be sent to assist a family include: suicide of Sailor, MIA, POW, and death of a Sailor’s spouse or dependent child or hospitalization (2) How Long Does a CARE Team Assist a Family? The intent is for the CARE Team to assist the family until extended family members arrive to support the family or when no extended family is available. Further, the CARE Team’s assistance is intended to be provided on a short-term basis, anywhere from 72 hours to two weeks. The actual length of time depends upon the family’s needs, Commander’s guidance and presence of other family members/friends to support the family. g. Building Trust, Respecting privacy and Maintaining Confidentiality as CARE Team Members

(1) Privacy is of the utmost importance to Sailors and families during times of trauma. It is expected that all CARE Team members in in this instance will keep personal matters disclosed to them in the strictest confidence. A more detailed discussion with specific examples of how to protect a family’s privacy is provided in the tips box. THE BOTTOM LINE: Protect the person’s privacy as you wish yours protected. (2) TIPS ON MAINTAINING CONFIDENTIALITY (a) Do not disclose specific details to anyone other than the CFRT Members, the Chaplain, the Casualty Assistance Officer, and the CARE Team members. (b) During the course of working with the sailor or family, you may learn many intimate details of the Sailor and family’s life. Keep their information to yourself. (c) Only give information with the permission of the Sailor, spouse and/or family involved. (d) Protect the person’s privacy when reporting to others. For instance, if you are informing the Chaplain of something that happened with the family, do not use names or specific details when others may be present. Move to a private area when possible. (e) When confidentiality does not apply. During the time you are assisting a Sailor or family, if there is any suggestion of any of the following issues: suicide, neglect, or assault, inform the person that you are obligated to report the situation. Depending on the severity of the situation, call 911, CO/FRO, and/or Chaplain. If there is a possibility of immediate danger to an individual, contact the police right away. If you are asked to keep their this type of information, which may be illegal or dangerous (to themselves or others) in confidence, inform the person that confidentiality does not cover these areas. (f) Have a clear understanding of what situations the CO expects to be reported to them. This information should be discussed with the CO before the FRO and CARE Team interacts with the Sailor or family. You should inform the person involved that they are touching on areas which you must report. Informing the person of your obligation to report to others is being honest with the person and gives them the choice of whether or not to continue the conversation, knowing the consequences if they choose to do so. If you are unsure about whether a specific situation falls outside the confidentiality areas or must be reported to the command, excuse yourself and contact your command POC/FRO and/or the Chaplain for advice.   

 

(5). Call Support (a) Screen calls and visitors according to family’s wishes. Verify with the family what information the family wants shared and what they do not what shared. Do not provide any information unless you are sure to whom you are talking and the family member has authorized the release of the information. Media inquiries should be directed to the appropriate Public Affairs Officer. (b) Keep a phone log. Write down the name of all individuals who call and associated telephone numbers. It may mean a lot to the spouse later to see who called and can be used by the family for sending thank you notes. Also, you can use it to call back those who wanted information on the funeral and memorial services. (c) Get a list of condolence phone calls received by the command. CMC should coordinate with CARE representatives to insure calls received by the command are delivered in a timely manner so they may be added to the family’s phone log. (d) Ask if there is anyone the spouse/family would like the CARE Team to contact. TIP: Making calls is the family’s responsibility. CARE volunteers, a Chaplain or a supporter outside the command can support the spouse through this process. (6) Home Care Assistance (a) Maintain a list of questions for the CACO. It is very helpful to have a notebook to write down any and all questions that the spouse/family has. Remind the spouse of the questions when the CACO is there so the CACO can answer them. Remember, the CARE Team should not be answering questions that pertain to CACO or Leadership responsibilities (benefits, entitlements, funerals, etc.)

(b) Maintain a list of questions for the CO . Write down any and all questions that the spouse/family has for the CO.

(c) Record visitors and gifts. Keep a logbook of flowers and gifts received along with a brief description including

A WORD OF CAUTION Let the family maintain control over what they can reasonably do for themselves. Let the family identify their needs rather than telling the family. Make suggestions or offer to help in a particular way, but you must seek feedback from the family on these suggestions/offers before taking action. It is important not to contribute to the family’s stress by being overbearing or “overly helpful”.

the identity of who gives them. Keep all cards. Keep a record of who visits the family, and if possible, who attends the memorial service. (d) Identify what household assistance is needed. Issues like laundry, housecleaning, lawn care, pet care/boarding, shopping, mail, or snow removal). Run errands as needed. Note: In the event the family needs money, this matter should be addressed with the CACO and CO who can assist the family in getting emergency financial assistance. (e) Maintain good communications with the command. Notify the FRO of any needs the CARE Team cannot address. For example, notify the command if the family needs translation services or has difficulties accessing services. (7) Childcare Support: FRGL/OMB If the family has children, the CARE Team should assess needs and support required. (a) Assess children’s needs and obtain information to include: (1) Ages of the children (2) Immediate childcare arrangements and needs while. (e.g., Does the family require someone to stay with any children at home so the adult(s) can meet with the CACO or attend to pre-departure needs if traveling to medical facilities to visit wounded Sailor?) (3) Children’s medical issues (it may be necessary for caretakers/babysitters to be aware of particular medical conditions/problems) (4) How death or injury was explained to child(ren) (so caretakers, babysitters and others are aware of what children have been told and have a sense of what can/cannot be said) (5) Whether children reside elsewhere (6) Children’s school and extracurricular activities; and what adjustments will be made while family is dealing with trauma situation, even if temporary (e.g does school require family authorization for someone other than a parent to pick a child up from class, will children stay at home and not attend school until time of funeral?) (7) Children’s transportation needs.

(b) Identify friends of family or children who may be willing to offer support. (This can be very helpful for teens.)

f. Meal Support (1) Go grocery shopping as needed. Be mindful of food allergies, dietary restrictions and preferences. Funds to purchase groceries are the responsibility of the family. This is to be funded by the family, CARE Team volunteers do NOT pay for groceries. (2) Coordinate meals for the family. Ensure food is also available for visiting family and visitors when they are at family’s residence. To make meal/food arrangements, will entail the following steps: - Identify special needs, food allergies, religious or dietary restrictions of family members. - Find out the types of dishes/foods family members (including children) prefer. - Identify out-of-town family members and friends expected to visit family. (3)Designate a Meal Coordinator. It is often helpful if the coordinator is a friend of the family so they can be a liaison between the family and those wanting to provide meals. The coordinator should:

(a) Manage the delivery of food and meal assignments as necessary. Consider keeping a log of all who provided food so that they can be thanked later.

TIP: It may be helpful and/or necessary to create a chart showing which volunteers or individuals can provide meals on which days. There are many online programs that can support this. (b) Ensure the family receives a variety of meals. Avoid providing the same meals unless requested by the family. (c) Monitor the quantity of food provided. A family may not want a meal delivered every night, but rather at specific intervals. Or a family may want food that they can put in the freezer and pull out as needed.

(d) Provide guidance to those wanting to provide food including: - Allergy and dietary restriction information - Children’s preferences - Snack items desired

- Times and locations for food drop off. - Format for meal preparation instructions (if dish will not be eaten immediately)

(e) Return dishes to owners as necessary.

g. Family Support (1) Assist visiting family and friends. This may include: - Offer assistance with access to installation, lodging, and/or transportation as needed.(pass request to CACO or FRO, as this is a command function) - Provide a welcome basket or information packet for out of town family.

TIP: Contact the local FFSC office in preparing an information packet. These offices often already have such packets. The Care Team would only need to supplement the packet with unit information, directions, and other pertinent information related to the situation or visiting family/friends’ needs. h. Assist family with personal arrangements related to funeral. This support is not to interfere with the CACO or responsibilities of the Command. Working collaboratively with the CFRT and with the invitation of the family support may include: (1) Help in getting necessary clothes for the funeral or memorial service. (2) Help family prepare if funeral is not local. (3) Ensure a guest book to the funeral and memorial service. (4) Coordinate with Public Affairs Officer to called media coverage (articles, videotapes) for family including a videotape of the memorial service. (5) Help arrange someone to housesit during the funeral and memorial service, if necessary. (6) Help family arrange location, food, preparation and clean up for a gathering held after the service, if the family elects at family home or at designated location.(If Command Function/coordinate/discuss with command) i. Assist family with arrangements related to visiting a wounded Sailor. This support is NOT to interfere with the CACO or responsibilities of the Command working collaboratively with the CFRT and with the invitation of the family support This may include: 

(1) Help in packing clothes (including clothes and items Soldiers may want or need while in hospital). (2) Help Ensure spouse/relative on Invitational Travel Orders has the following documents assembled prior to traveling: - Copy of Invitational Travel Order (ITO) - Military ID card - Power of Attorney - Immunization records for traveling child(ren) (-) Name and phone number of the Sailor’s command (-) Valid passport if traveling overseas (If a family member does not have a passport, one can be obtained quickly through the CACO.

(3) If asked help coordinate with CFRT/CACO on travel arrangements. (e.g., transportation to and from airport, local transportation information or car rental in location of wounded Sailor.) (4) If asked help make necessary arrangements for family members that will remain in the home (e.g., children, elderly parents, individuals with special needs) (5) Discuss necessary house arrangements for extended period of absence (e.g., pet boarding, house sitting, stopping mail and newspaper service, lawn care, house plant care, snow removal, and emptying refrigerator) (6) Cancel and/or change personal appointments (7) Obtain notification or releases for children’s day care and schools. (8) Arrange or provide transportation. This may be helpful as the intense emotions a family experiences can make an individual too tired or too distracted to drive. Discuss with CFRT/CACO and family. (9) Accompany family to local hospital. This can be a helpful way to support families of wounded Sailors. Discuss with CFRT/CACO and family. Remember to respect the Sailor and families privacy. (10) Offer family a stress relief break. Take Meet spouse and/or children out for a meal or an activity to have a break and enjoyable activity. This can be helpful to both families of fallen and wounded Sailors.

f. Tips on Dealing with Individuals’ Grief and Trauma Reactions

(1) Do’s

(a) Express your sorrow for the deceased and the family. Say you are sorry about the griever’s pain and the situation. Simply say, “I’m sorry” or, “Words fail me.” (b) Remember to extend condolences to forgotten mourners: grandparents, siblings, stepchildren, aunts and uncles, and cousins. Be observant of the children. Children mourn too. (c) Be compassionate and sensitive. (d) Accept diversity in how individuals respond and cope. Accept grief and anger as normal reactions. (e) Let individuals know that their reactions are normal. (f) Be patient. Give the individual time to grieve and recover. Avoid judgments about the family and the tragic situation. (g) Listen quietly and non-judgmentally. Allow the family to talk and in the early stages of grieving, to take the lead in conversation. Allow family members to express as much grief as they are feeling at any given moment and are willing to share. The family needs “permission to grieve.” Allow the family to talk about the endearing qualities of the person that has died. (h) Be comfortable with just being silent and not talking. Also, if you do not know what to say, that is okay. Sometimes it is hard to find the words that convey what you are feeling for the family and their loss. That is perfectly all right. Sometimes the best way to comfort is just by being with them. Your presence is all that is needed and is the one thing that is most appreciated. (i) It is a good practice to mention the deceased by name. (j) Arrange or provide practical assistance and support as appropriate. Also encourage individual to ask for help. Be aware that it is often difficult for grieving people to reach out for help. (k) Let your genuine concern and caring be visible. Accept that it is not possible for you to make the grieving person feel better. Be accessible, but not pushy. (l) Sometimes the family just does not want to see anyone because they are tired or just want to be alone. Do not take this t

personally, but give them the space needed. If you sense that “traffic control” is warranted, step in and be the gate keeper. (m) Encourage family to take care of themselves (i.e., eat properly and get rest). (n) Ensure family does not become isolated. Encourage family to have contact with their support network and connect with others. (2) Don’ts (a) Don’t be afraid of silence. Don’t be afraid of tears. (b) Don’t inhibit open communication. For example, don’t change the subject when the griever mentions the deceased/wounded. (c) Don’t let your own sense of helplessness or discomfort; keep you from reaching out to the family. (d) Don’t answer questions about the injury or death. It is common for families to have questions, but refer family to CACO or Command Leadership/RBL. (e) Don’t impose your explanation on why their this has happened. Don’t try to answer the question, “why?” (f) Don’t say “I know how you feel” or “Everything will be all right”. (g) Don’t say anything that implies a judgment about the family’s feelings: “You ought to be feeling better now” or “You’ll be feeling better in a month or so” or “I know how you feel.” Don’t encourage the family to “get over it”. (h) Don’t make statements or ask questions that induce guilt or affix blame. (i) Don’t treat the family like invalids. Let the spouse/family be in control and do the things that they want to do for themselves. There is a tendency for volunteers and those trying to give assistance to overdo it. Although well intended, for the family, this can become very trying at times. Keep in mind that the family may be experiencing anger and a sense of loss of control so little things can become big things. The bottom line is, if the family wants to get their own coffee, get their own sandwich, answer their own phone, etc., let them. (j) Don’t be too direct or give advice. (For example, don’t make suggestions regarding packing up clothes, photos, etc.)

(k) Don’t try to find something positive in the death. Don’t make statements, such as “God knows best” or “It’s God’s will”. (l) Don’t impose your own religious beliefs or discount those of the family. Respect family’s religious and cultural beliefs. (m) Don’t assume anything. For example: if the widow or spouse of wounded isn’t crying, don’t assume she’s not upset or if she’s screaming, don’t assume she can’t care for herself or her family.

Source: This is a compilation of lessons learned, best practices and adaptation of information provided in Army War College’s A Leader’s Guide to Trauma in the Unit, Navy EOD Ombudsman Battle book, Fort Sill’s Care Team training and Phantom Thunder Care Team Guide, Fort Riley’s CDR/1SGT Course, Deployment Health Clinical Center’s fact sheet entitled A Normal Reaction to an Abnormal Situation, and US Army Operation READY Rear Detachment Commander’s training.  

Types of Trauma Events

Individuals Exposed: Sailors and Families Community/Command Exposed (Mass Trauma)

Intentional Trauma

Unintentional Trauma

Human Made Natural Made

Examples: Sexual

Assault Physical

Assault Robbery Rape

Examples: Accident Injury

Examples: Terrorism War Transportation disasters

(e.g., plane crash) Shootings/kidnapping/hostag

e situation Industrial Accident

Example: Tsunami Hurricane Tornado Flood Earthquake

It is not uncommon for individuals to have experienced a traumatic event. Individuals can be exposed to trauma in different ways: physical impact (i.e., injury), visual exposure (i.e., witness), know someone hurt or exposed to trauma, and media (which results in repeated exposure). With many trauma events, it is not just the individual impacted, but an entire family or community. For example, when a Sailor is injured or killed in action the entire command, military community, and civilian community where the Sailor resided may be impacted. 4. Key facts to keep in mind about traumatic events

a. Traumatic events may create extreme stress, intense fear, helplessness or horror. Individuals can feel isolated from others by the experience. b. Traumatic events are different from normal stressful events. Traumatic events are unanticipated and may create a prolonged sense of crisis and lack of control feeling. c. Some traumas create additional stressors such as loss of routine, job loss, loss of financial income, relocations/displacement of family or children, and the need to navigate government and insurance systems for assistance. d. Some traumatic events, as in the case of natural disasters for instance, can cause disruption in community and social supports making it difficult for individuals to get help. e. Traumatic events involve loss whether it is a death, destruction of property or community, or a symbolic loss (e.g., loss of sense of security, loss of ability to trust other people, loss of predictable future). Mass traumas often involve personal, community and symbolic loss. f. With any trauma, individuals of all ages may struggle to find meaning in the event.

5. How do individuals respond to traumatic events? Individuals’ (both children and adults) reactions to traumatic events reflect their response to stress, intense fear, helplessness, vulnerability, and loss. Their response involves physical (bodily), emotional (feelings) and cognitive (thoughts) reactions. Individuals’ reactions to traumatic events vary considerably and can have varying impacts. For some individuals, the reactions cause a mild disruption in an individual’s life whereas others exhibit severe and debilitating impairment in functioning.

a. Normal Trauma Reactions. Individuals will have many reactions. The constellation of responses seen both in adults and children can be wide ranging. Some responses, such as grief, depression and anxiety, include a variety of additional and overlapping symptoms. For some individuals, the cluster of reactions represents symptoms of acute stress disorder (ASD) or posttraumatic stress disorder (PTSD), but not necessarily a diagnosis of ASD or PTSD. Symptoms of PTSD are not uncommon, and most will recover after a period of time. b. Reactions to Loss and Death. Traumatic events can involve sudden loss or death. A sudden loss of a Sailor, child or family member is particularly difficult when death has occurred under any of the following circumstances: (1) Death occurred without warning and opportunity to say goodbye (2) Death occurred as result of violence (3) Death in which body is never recovered (4) Multiple losses (e.g., mass casualty) (5) Death occurred as result of willful misconduct of others (e.g., accidents, war, and terrorism) In the case of war, Sailors can experience the sudden loss of a significant and close attachment. Initially, reactions to their traumatic loss may involve a wide range of intense emotions. Over time the frequency and intensity of these emotions are expected to diminish in a normal grieving process. 6. Traumatic Grief. Traumatic deaths or sudden loss of significant and close attachment can lead to a grief process that is more complicated and difficult to resolve. Traumatic grief occurs when an individual shows extreme distress over an extended period of time and that grief dominates an individual’s life. It is not uncommon for these individuals to experience intense reactions including agitation, suicidal ideation, and powerful rage (e.g., anger toward those perceived to be responsible) or revenge fantasies. These individuals

Common Trauma Reactions

Grief/Traumatic grief (if sudden loss Anger/Irritability

Fear Confusion

Disbelief/shock Unexplained somatic symptoms

Numbing and withdrawal Depression

Helplessness Anxiety

Feeling Jumpy Easily startled Nightmares/flashbacks

Sleep disturbances Distrust

may also have frightening memories/thoughts about the traumatic event by either agonizing about what their loved one experienced during the final moments of life or recalling the horror of the traumatic event they experienced. These frightening memories/thoughts along with the intense symptoms of distress are over and above the normal symptoms of bereavement and disrupt the grieving process. 7. Post-traumatic Stress Disorder (PTSD). Symptoms of PTSD can also occur. In the context of a traumatic death, PTSD symptoms may appear as follows: a. Re-experiencing the traumatic event by having painful, intrusive thoughts or nightmares about the death. b. Avoidance or emotional numbing (e.g., staying away from places, activities, or things related to the loved one’s death). c. Increased persistent anxiety and physiological arousal (e.g., difficulty sleeping, irritability, difficulty concentrating, tendency to be startled easily). While these symptoms are normal symptoms of grief, when all of these symptoms occur together and persist then the individual may be experiencing PTSD and should be referred for professional help. 8. Secondary Trauma and Trauma Reactions. Individuals can be traumatized indirectly. Secondary trauma can occur when learning about someone’s (typically a loved one for families) trauma or through frequent interactions with a trauma victim and the victim’s trauma symptoms (as in the case of both Sailors, family members, and unit responders such as CACO’s, Ombudsman, FRGL’s, FRO’s, Chaplains, and command leadership). The trauma reactions seen will be similar to the normal trauma reactions described earlier. The only difference is that in secondary trauma, the trauma reactions are associated with a trauma victim rather than the trauma event. 9. Other Facts about Trauma Reactions. Key facts to keep in mind about individuals’ responses to trauma a. Initially, individuals may have intense reactions. b. In many mass trauma situations, such as war and natural disasters, individuals’ use of media increases. c. Individuals’ reactions will change with the phases of the trauma event. (There are four phases to a trauma event: impact, immediate post trauma/rescue, early short term/recovery, and long-term/“return to life”). Early responses to a trauma event reflect survival and adapting to perceived harm to self or others. In recovery and later, responses reflect individuals’ efforts to cope with changed reality. d. Sailors and family’s reactions to trauma occur in parallel.

e. Reactions and abilities to cope with trauma event depend on various factors that include: (1) Circumstances of trauma event (2) Perceptions of the event’s meaning (3) Ways individuals manage their emotions and cognitions (4) Recovery environment. f. Most people are resilient and do ok over time. g. Most people will not develop a psychiatric disorder. The PTSD Alliance reports 20% will develop PTSD after a traumatic event. However, responses left untreated can lead to serious disorders. h. Trauma can lead to personal growth (e.g., greater self reliance, stronger relationships, reevaluation of spiritual beliefs, and greater appreciation of life or rethink priorities). 10. Why Do Individuals Respond The Way They Do To Traumatic Events? It is important to keep in mind that traumatic events create stress. Individuals’ reactions to trauma both in the immediate aftermath and the months and years after the event reflect how individuals cope with stressful situations and change. It is difficult to predict how any given individual or family will respond. There are three sets of factors that determine how individual and families will respond.    a. Circumstances of Traumatic events. Reactions to traumatic event are dependent upon circumstances of the trauma such as: (1) Type or causality of traumatic event — Situations in which a deliberate intentional effort to intimidate, control, or do harm to individuals are very different forms of trauma than nature made or accidents. Intentional and human made traumas tend to have a greater number of, more complex, and longer duration of psychological effects. (2) Whether single event, multiple events (e.g., 9/11), or ongoing (e.g., war, abuse) — Multiple or ongoing trauma creates a sense of fear, dread, and rage over expected repeated trauma. 7 (3) Amount and level of exposure — the greater proximity to or exposure to trauma event, the greater the impact. (4) Nature of losses — Losses, other than death, can result in grief or depressed state reactions. (5) Ambiguous loss — According to Pauline Boss, 8 certain situations create ambiguous loss. Ambiguous loss occurs: 1) when

individuals are physically present, but psychologically not present (e.g., mental health disorder, war wounded, distressed parent, parent preoccupied with work) and 2) when individuals are psychologically present, but not physically present (e.g., military deployments, missing in action). These situations are stressful because the uncertainty is experienced on an ongoing basis with no closure. The stress of the uncertainty can impact family coping and relationships. For example, for military families, the ambiguity of not knowing whether the Sailor is dead or alive in a combat deployment can create a stress that is traumatizing and immobilizing (e.g., relationships and daily functioning are put on hold).

b. Individual/Family Characteristics. How individuals (and families) respond behaviorally and emotionally is determined by a number of personal factors including: (1) Temperament – Individuals’ personality traits often determine how individuals respond to extreme stress. (2) Resources – Individual and family resources shape coping behavior. Individual resources are: (a) Financial well-being (b) Educational (problem-solving abilities, information) (c) Health (physical and emotional well-being), and (d) Psychological resources (self-esteem) (e) Family resources include family cohesion and adaptability (ability to change) (3) Culture – An individual’s cultural beliefs can impact how an individual perceives the event, expresses emotions, and seeks help. (4) Coping style – Individuals may use different coping strategies in different phases of a trauma situation. Two different coping styles are generally seen, either avoidance (e.g., withdrawal) or approach (e.g., take action). (a) Family coping style. Family coping style has been described as either a mastery (i.e., family perceives they have resources or access to resources to exercise some control over the situation) or fatalistic orientation (i.e., family believes they do not have resources to deal with the trauma). 11 When families take mastery orientation, they take a solution-oriented approach in contrast to fatalistic orientation which leads to passive behavior. (b) Effectiveness of coping strategies. Coping strategies can be effective or ineffective. Further, ineffective coping strategies can add to source of stress. Research has shown that

individuals who use withdrawal and avoidance responses are more likely to have greater posttraumatic distress, PTSD and failure to recover than those who use problem-solving or adaptive coping skills. (It is important to note that avoidance and hyper-vigilance are ways individuals typically cope with repeated loss and death.) Other coping strategies considered ineffective are drinking, denial, avoiding talking about trauma, and regression (in children). According to Peebles-Kleiger, families may initiate controlling behaviors in response to the feelings of helplessness and these behaviors often do not “restore equilibrium and typically create additional harm”. (5) Past history of trauma and loss – Previous trauma can have a positive or negative effect. If an individual experienced mastery (or positive meaning) with previous trauma, then an individual may display increased strength in their ability to cope with subsequent trauma situation. However, individuals who have experienced prior traumas can be more vulnerable to development of PTSD. (6) Preexisting stressors – Stressors (such as marriage, divorce, serious health problems, job loss and family-related difficulties) preceding the trauma event can make an individual more vulnerable to traumatic stress reactions. (7) Spirituality and beliefs – Traumatic events often cause people to question their beliefs about safety, trust, power/control, esteem and intimacy. For example, war (or combat deployments) often raises questions about moral and ethical beliefs. For example, terrorist attacks cause people to question their beliefs that the world is safe, secure and predictable. Their questioning reflects individuals’ and families’ perceptions of their vulnerability, safety and control in the world which shapes how they respond. For example, families often feel a need to focus on safety and thus can show hyper-vigilance and control behaviors. (8) Perception about meaning of events – How individuals and families perceive events is a significant factor in the degree to which an event distresses individuals and families. Their interpretation affects the nature of individuals’ coping and responses. For example, Sailors may deal with war by finding meaning and gratification in helper role. 16 A child who blames him/herself when a bad thing happens is likely to become distressed.

(9) Mental illness prior to event – Individuals who had mental health problems or illness prior to event is likely to have problems following a traumatic event.

These factors can serve as individuals’ strengths which enable individuals/families to show resilience or areas of vulnerability which lead to mental health problems/disorder. Individuals (and families) vary greatly in their strengths and vulnerabilities. The interaction of all these factors is complicated (see boxes below) and

thus it is difficult to predict how any given individual (or family) will respond.

c. Support System and Recovery Environment. The focus is on the factors in the informal and formal support network that impacts individuals’ (and families) ability to get aid and regain normal functioning. (1) Family – Individuals often turn to family as a source of support when they are stressed. Other family members’ reactions can influence an individual. For example, it has consistently been shown in the literature that children’s reactions are closely related to parents’ reactions to trauma. (2) Community – Community response and social support can mediate adverse effects of trauma events. For example, community-wide response (e.g., community mourning together) can aid group recovery, when mass trauma occurs. Community attitudes and perceptions can also influence community support efforts and individual reactions. For example, perceptions and attitudes about war have been known to influence the level of support Sailors and families receive.

A WORD ABOUT SOCIAL SUPPORT Social support is regarded as an important resource for families when dealing with stress21 and coping and adapting to a traumatic event. Social support refers to both information disseminated to facilitate problem-solving and development of new social contacts that provide help and assistance.

 

A WORD ABOUT WHY RESILIENCE OCCURS Resilience is the ability to bounce back to a level of functioning equal to or greater than before the stressor event. To achieve this, an individual must be able to be flexible and stay healthy/thrive (i.e., maintain physical and emotional health and spirit for living) in times of undue stress. 19 Individuals can attain resilience in different ways.

A WORD ABOUT WHY DISTRESS AND MENTAL HEALTH PROBLEMS OCCUR An individual’s (families) responses to a stressor event and stress are shaped by the adequacy of individual (and family) resources along with their perceptions of the meaning of the event. If resources are overwhelmed and negative view is taken, then responses are likely to be maladaptive. In contrast, individuals who have sufficient resources and who reframe events or view event as opportunity for growth adapt better. The nature of individual/family responses determines the level of stress experienced When mental health problems or impairment in

Young Children  (0‐5 years)    

• Crying 

• Fear of being separated from 

parent 

• Clinging 

• Whimpering 

• Change in sleep and eating 

habits 

• Regression in behavior (e.g., 

bedwetting, fear of darkness, 

thumb sucking)  

• Repetitive play or talk 

(especially children less than 

3 years old) 

• Screaming, tantrums, irritable 

outbursts (especially 3‐5 year 

olds) • Withdrawal (especially 3‐5 

year olds) 

 

10. Do Children Respond In The Same Way As Adults? What Effects Children’s Reactions to Trauma?

Normal Children’s Reactions to Trauma and Death

School Age (6-12 yrs). Like adults, children will display a variety of reactions and feelings in response to the stress, fear, and loss experienced with a traumatic event (such as combat deployment or parent’s death). Not all children will exhibit all symptoms and their reactions will change over time. Some symptoms will be short-lived whereas other symptoms may persist. Some symptoms may not occur until years later. As with adults, mental health problems can subsequently appear. The problems most likely to be seen are posttraumatic stress disorder, anxiety and depression. The nature of children’s reactions to a traumatic event and their risk of developing a mental health problem depend on the same three factors as described for adults: circumstances of trauma event, individual and family characteristics, family and community support. Here is a closer look at the key factors as it relates to children.

School­age  (6­12 years)   • Crying 

• Withdrawal • Unable to pay attention 

• Anger/disruptive behaviors (e.g., 

fighting, bullying, aggression) 

• Nightmares sleep disturbances 

• Irritability 

• Fear 

• Self blame or guilt 

• Fluctuating moods 

• Physical complaints (e.g., stomach 

aches, headaches) 

• School problems (e.g., academic 

difficulty or decline, difficulty 

concentrating, school refusal) 

• Clinging (especially 6‐9 year olds) 

• Regressive behaviors (especially 6‐

9 year olds) 

• Resentment (especially 9‐12year 

olds)  

• Suppressed emotions or denial (9‐

12year olds) 

• Sadness, depression (especially 9‐

12year olds) 

• Anxiety (9‐12year olds) • Repetitive talk with peers or 

thoughts (9‐12year olds)  

Teens and Adolescents (13‐ 18 years)  

• Suppressed emotions or denial;   Emotional numbing 

• Re‐experiencing 

• Avoidance of feelings 

• Acting out (engaging in risky, 

antisocial or illegal behavior) 

• Resentment 

• Guilt 

• Depression and/or suicidal 

thoughts 

• Distancing, withdrawal 

• Mood swings 

• Anxiety, panic 

• Anger 

• Fear 

• Appetite and sleep changes 

• Nightmares 

• Physical complaints (e.g., stomach 

aches, headaches) 

• Difficulty with peers 

• School problems (e.g., academic 

difficulty or decline, difficulty 

concentrating, school refusal) • Increased dependence or 

independence  

 

Family Characteristics and Support

• Parent’s reactions – This is one of the most significant factors that determine how

children react. 26 Children’s emotions can be in reaction to or mimic parent’s

reactions. Also children may be affected if parent is preoccupied with event and thus

not available physically or emotionally.

• Family’s functioning style and relationships – The nature of a family’s communication

and the way family members interact and support one another will determine the level

of comfort and assurance children receive. A lack of family support makes children

more vulnerable to having difficulties. • Changes in family life due to event – These changes can create additional stresses that can have a negative effect or influence children’s reactions.

Individual Characteristics

• Age – Children of different ages display emotions in different ways. For example, 3 to

5 year old children may display anger by fighting and throwing tantrums whereas 9 to

12year old children may exhibit aggressive and bullying behavior.

• Cognitive level – Cognition influences children’s understanding of an event or death,

which in turn influences children’s emotional and behavioral responses. Also keep in

mind that fear (e.g., fear about parent’s death, fear about safety) is normal at

certain developmental stages. A traumatic event can heighten a child’s normal fears.

• Ability to cope – Children, especially young children, have less well developed coping

strategies than adults. Thus they may have difficulty knowing how to handle their own

feelings or can become overwhelmed by their feelings.

• Child’s personality – A child’s personality and temperament influence how a child

responds, although these traits can become exaggerated. For example, an anxious child

may become more fearful.

• Child’s relationship with deceased parent – The nature of this relationship may

determine how children feel the loss and their emotional recovery.

• Child’s prior experiences with trauma – Children are more likely to be severely

impacted if they have already suffered from a trauma. • Child’s preexisting mental health problems – Children who have mental health problems illness prior to an event are more likely to have difficulties following the event.